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Gut 61:1716-1722 doi:10.1136/gutjnl-2011-301135
  • Original articles
    • Colon

CT colonography for detection and characterisation of synchronous proximal colonic lesions in patients with stenosing colorectal cancer

  1. Hyun Kwon Ha1
  1. 1Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
  2. 2Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
  3. 3Department of Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
  4. 4Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
  5. 5Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
  1. Correspondence to Dr Seong Ho Park, Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Asanbyeongwon-gil 86, Songpa-gu, Seoul 138-736, Korea; parksh.radiology{at}gmail.com
  1. Contributors Study concept and design: SHP, JHL, AYK, HKH. Acquisition of data: SHP, JHL, SSL, JCK, CSY, HCK, BDY, M-JK, AYK. Analysis and interpretation of data: SHP, JHL, BDY, M-J K. Drafting of the manuscript: SHP, JHL. Critical revision of the manuscript for important intellectual content: SHP, JHL, SSL, JCK, CSY, HCK, BDY, M-JK, AYK, HKH. Statistical analysis: SHP, JHL. Administrative, technical, or material support: SSL, JCK, CSY, HCK, BDY, M-JK, AYK. Supervision: SHP, HKH. Final approval of the version: SHP, JHL, SSL, JCK, CSY, HCK, BDY, M-JK, AYK, HKH.

  • Revised 11 October 2011
  • Accepted 14 October 2011
  • Published Online First 23 November 2011

Abstract

Objective To investigate CT colonography (CTC) performance for detecting and characterising synchronous lesions proximal to a stenosing colorectal cancer and to suggest patient management strategies according to the CTC findings.

Methods 411 consecutive patients underwent CTC for proximal colonic evaluation after failed colonoscopy past a newly diagnosed stenosing colorectal cancer. Pathological examination of colectomy specimen and/or postsurgical colonoscopy with pathological confirmation of the proximal synchronous lesions to serve as reference standards existed in 284 patients. Per-patient and per-lesion diagnostic performance measures of CTC for diagnosing proximal synchronous lesions ≥6 mm analysed by histopathological categories were obtained for the 284 patients. Per-lesion sensitivity and positive predictive value (PPV) of various CTC lesion size criteria and lesion size combined with other CTC findings for diagnosing cancer in the proximal colon were determined.

Results Both per-patient and per-lesion CTC detection sensitivities for proximal synchronous cancers were 100% (6/6 patients and 8/8 lesions; 95% CI 64.3% to 100% and 70.7% to 100%, respectively) with the corresponding per-patient negative predictive value (NPV) of a negative CTC of 100% (194/194 patients; 95% CI 98.3% to 100%). Per-patient NPV of a negative CTC for advanced neoplasia (ie, advanced adenomas and colorectal cancers) was 97.4% (189/194 patients; 95% CI 93.9% to 99.1%). A lesion size ≥15 mm on CTC as the criterion to specifically diagnose proximal cancer yielded 87.5% (7/8 lesions; 95% CI 50.8% to 99.9%) per-lesion sensitivity, rendering one 8-mm submucosal cancer mischaracterised as a non-cancerous lesion, and 70% (7/10 lesions; 95% CI 39.2% to 89.7%) per-lesion PPV. Additional CTC findings did not improve the sensitivity.

Conclusion CTC is highly sensitive in detecting synchronous cancers proximal to a stenosing colorectal cancer. CTC has limited capability in differentiating advanced adenomas from colorectal cancer and this compromises the PPV of CTC for the presence of proximal cancer.

Footnotes

  • SHP and JHL are co-first authors.

  • Competing interests None.

  • Ethics approval Ethics approval was provided by the IRB of Asan Medical Center.

  • Provenance and peer review Not commissioned; externally peer reviewed.